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  • 1.
    Ahlzen, Rolf
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Illness as unhomelike being-in-the-world?: Phenomenology and medical practice2011In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 14, no 3, p. 323-331Article in journal (Refereed)
    Abstract [en]

    Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.

  • 2.
    Ahlzén, Rolf
    Karlstad University, Faculty of Social and Life Sciences, Avdelningen för hälsa och miljö.
    Why should physicians read?: Understanding clinical judgement and its relation to literary experience2010Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis.

    In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine.

    The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.

  • 3.
    Edebol, Hanna
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Global Assessment of Attention Deficit Hyperactivity Disorder: Examining Objective Measures of Hyperactivity, Impulsivity and Inattention in Adults2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing. Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.

    Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder. Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms). Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with diconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms. In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.

    The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.

     

     

  • 4.
    Grahn Vera Gajardo, Jannette
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. 6406282787.
    ”Man vill ha bekräftelse på att allt rullar åt rätt håll” - En intervjustudie om föräldrars upplevelse av 3-års teambesöket på BVC i Värmland2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Föräldrarnas levnadsvanor kan vara avgörande för hur barnets framtida levnadsvanor kommer att se ut och är därför väsentliga ur ett folkhälsoperspektiv.

     

    Syftet med denna studie var att undersöka de värmländska föräldrarnas upplevelse av 3-års teambesök på barnavårdscentralerna (BVC) i Värmland. Teambesöket, där både barnhälsovårdsläkare och barnhälsovårdssjuksköterska träffar föräldrarna tillsammans har som syfte att prata om levnadsvanor med alla föräldrar ur ett hälsofrämjande perspektiv som innebär att utgå från faktorer som bidrar till att främja och bevara hälsan.

     

     

    För att svara på syftet användes kvalitativ induktiv metod. Urvalet, tio föräldrar, var strategiskt och kompletterades med ett bekvämlighetsurval. Datainsamlingen skedde genom intervjuer som spelades in, transkriberades och analyserades med kvalitativ innehållsanalys metod. Resultatet från denna studie visar att upplevelsen av 3-års teambesöket på BVC i Värmland skiljer sig åt avseende personalens bemötande. Faktorer som avgjorde upplevelse av ”det goda mötet” berodde inte endast på BVC-personalens tidsbrist utan upplevelsen påverkades också av förhållningssättet, innefattande struktur och arbetssätt på teambesöket. Det var viktigt för en positiv upplevelse att känna att alla blev delaktiga i ett samtal som inte är utpekande och som kan ge möjlighet till reflektion samt bekräftelse på att man som förälder gör rätt.  Det är dessa aspekter som leder till att föräldrarna känner sig stärkta i sitt föräldraskap. Föräldrarna upplevde levnadsvanefrågor som viktiga likaså uppföljningen av BVC samt att tilliten till BVC:s arbete med att övervaka och följa upp barns hälsa var stark.

     

    Mot bakgrund av studiens resultat föreslås åtgärder för att förbättra struktur, samarbete och roller på teambesöket på BVC i Värmland.

  • 5.
    Grim, Katarina
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Rosenberg, David
    Umeå universitet.
    Svedberg, Petra
    Högskolan Halmstad.
    Schon, Ulla-Karin
    Högskolan Dalarna.
    Development and Usability Testing of a Web-Based Decision Support for Users and Health Professionals in Psychiatric Services2017In: Psychiatric rehabilitation journal, ISSN 1095-158X, E-ISSN 1559-3126, Vol. 40, no 3, p. 293-302Article in journal (Refereed)
    Abstract [en]

    Objective: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. Method: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Results: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. Conclusions and Implications for Practice: This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives.

  • 6.
    Kane, Bridget
    et al.
    Trinity College Dublin, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Clinical Training and Teamwork: Learning and Feedback2015In: 2015 IEEE 28th International Symposium on Computer-Based Medical Systems, IEEE, 2015, p. 280-285Conference paper (Refereed)
    Abstract [en]

    MDTMs are now a feature of routine hospital work and provide a valuable learning opportunity for education and practice development. The popularity of the forum as a patient management mechanism has had a negative counter effect on the educational function of the forum. Behavioural interventions and technical supports are identified based on long term ethnographic studies to restore the educational benefits of the forum. The potential for re-developing the MDTM into a rich educational resource that will assist in clinical education, professional development, provide an evidence base for guideline development by integrating clinical outcome feedback into the meeting record is proposed.

  • 7. Liebiedieva, Svitlana
    et al.
    Haas, Jan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Andersson, Jan-Olov
    Geospatial support2017In: Handbook of Disaster and Emergency Management / [ed] Amir Khorram-Manesh, Göteborg: Amir Khorram-Manesh , 2017, p. 92-96Chapter in book (Refereed)
  • 8.
    Moniruzzaman, Syed
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Divergent trends in emergency department visits for poisonings by intent in Värmland, Sweden2016Conference paper (Other academic)
  • 9.
    Vikstrom, Pernilla
    et al.
    Lunds universitet.
    Bjorkman, Anders
    Lunds universitet.
    Carlsson, Ingela K.
    Lunds universitet.
    Olsson, Anna-Karin
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). NU Hlth Care, Dept Psychiat, Trollhattan.
    Rosen, Birgitta
    Lunds universitet.
    Atypical sensory processing pattern following median or ulnar nerve injury: a case-control study2018In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 18, article id 146Article in journal (Refereed)
    Abstract [en]

    Background: Due to brain plasticity a transection of a median or ulnar nerve results in profound changes in the somatosensory areas in the brain. The permanent sensory deprivation after a peripheral nerve injury might influence the interaction between all senses. The aim of the study was to investigate if a median and/or ulnar nerve injury gives rise to a changed sensory processing pattern. In addition we examined if age at injury, injured nerve or time since injury influence the sensory processing pattern. Methods: Fifty patients (40 men and 10 women, median age 43) operated due to a median and/or ulnar nerve injury were included. The patients completed the Adolescent/Adult Sensory Profile questionnaire, which includes a comprehensive characterization on how sensory information is processed and how an individual responds to multiple sensory modalities. AASP categorizes the results into four possible Quadrants of behavioral profiles (Q1-low registration, Q2-sensory seeking, Q3-sensory sensitivity and Q4-sensory avoiding). The results were compared to 209 healthy age and gender matched controls. Anova Matched Design was used for evaluation of differences between the patient group and the control group. Atypical sensory processing behavior was determined in relation to the normative distribution of the control group. Results: Significant difference was seen in Q1, low registration. 40% in the patient group scored atypically in this Quadrant compared to 16% of the controls. No correlation between atypical sensory processing pattern and age or time since injury was seen. Conclusion: A peripheral nerve injury entails altered sensory processing pattern with increased proportion of patients with low registration to sensory stimulus overall. Our results can guide us into more client centered rehabilitation strategies.

  • 10.
    Wagnsson, Stefan
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Educational Studies (from 2013).
    Föreningsidrott och ungas psykosociala hälsoutveckling.2017In: Idrottens samhällsnytta : En vetenskaplig översikt av idrottsrörelsens mervärden för individ och samhälle. / [ed] J. Faskunger & P. Sjöblom, Stockholm: Riksidrottsförbundet , 2017, p. 54-68Chapter in book (Other academic)
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